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Ancient deposits of ferricrete (stratified iron oxyhydroxide or clastic sediment cemented by stratified iron oxyhydroxide) are present inheadwater streams draining an historic mining district in the Rocky Mountains, USA. These deposits, which form under conditions of low pHand high metal concentrations, are present in streams draining many other mineralized areas. Radiocarbon dating of wood fragments entombed within the ferricrete indicates dates of deposition as old as 8840150 years before present (b.p.). The ferricrete deposits provide evidence that natural, metal-rich acid rock drainage has been occurring inthis mineralized region for thousands of years, due to the weathering and oxidation of exposed or near-surface massive sulfide ore deposits. The dating and chemical composition of the ferricrete deposits have applications to the environmental remediation of historic mining sites and to environmental issues related to natural background chemistry. In addition, the radiocarbon dates of the ferricrete deposits correlate closely with warm-wet periods in the Holocene record, showingthat ferricrete deposits may represent a previously untapped source of paleoclimatic information. [ABSTRACT FROM AUTHOR]

Objective: To assess the safety, efficacy, and patient acceptability of a pacemaker home monitoring (HM) service., Methods: All patients receiving a new Biotronik (Biotronik, Berlin, Germany) pacemaker between March 2020 and February 2021 were contacted for participation. Participants were surveyed on their experience of pacemaker HM. HM alerts and remote wound monitoring rates were also assessed., Results: Of the patients contacted, 77% responded, with a mean age of 80.6±9.9 years. Of these, 95.8% agreed that the home monitoring (HM) has been beneficial. Two thirds preferred HM to face-to-face follow-up and two thirds felt safe with HM. Three themes were identified from the comments: reassurance, technology and data security. Forty-one percent (41%) of respondents would like more reassurance that their HM is working, 18% mentioned technology with mixed responses, and 4.7% cited cybersecurity or the use of their personal data as a concern. The average one-way patient journey saved was 24.3±16.7 km (15.1±10.4 miles). One in three HM alerts required action but only 3.4% were urgent. Remote wound review was successful in 59%., Conclusions: The majority of patients prefer HM and almost all think it has been beneficial. It saves significant travel time and provides actionable alerts. The patient experience could be improved by reassuring patients that their device is being monitored., (Copyright © 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Cardiac tamponade is an important and severe consequence of pericardial effusion. Patients with haemodynamically significant pericardial effusions present with signs and symptoms relating to the degree of their impaired cardiac function. Although autoimmune disease is a recognised cause of pericardial effusion, cardiac tamponade as a clinical presentation of primary adrenal insufficiency (PAI) is infrequently reported. We present a case of a woman, in her early 50s, who was admitted to the coronary care unit with cardiac tamponade caused by an acute adrenal crisis from unrecognised PAI. We hope to raise clinicians' awareness of PAI as a rare but important cause of cardiac tamponade., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Cardiac implantable electronic device (CIED)-related complications and infections typically lead to prolonged hospital stays and, very occasionally, death. A new CIED insertion protocol was implemented in a district general hospital. The primary objective of this study was to determine whether a significant reduction in complication and infection rates occurred after implementation of the new protocol. Medical records were reviewed for patients who had a CIED inserted in the two years pre- and post-protocol implementation, and any complications were identified in a one-year follow-up period. An increase in the complexity of the devices implanted after introduction of the protocol was observed. The number of complications was significantly reduced from 6.86% to 3.95% (p<0.0001). In the two years prior to protocol implementation, 14 of 871 (1.6%) patients suffered a CIED-related infection. In contrast, four of 683 (0.44%) patients suffered a CIEDrelated infection in the two years postimplementation. This was not statistically significant (p=0.093). In conclusion, implementing a standardised protocol for CIED insertion significantly reduced the rate of complications, and also reduced the rate of infection, but this was not statistically significant., Competing Interests: MD reports receiving speaker fees from Biotronik in the past 2 years. EF, GF: none declared., (Copyright © 2021 Medinews (Cardiology) Limited.)

Aims: Endocardial left ventricular (LV) pacing is a viable alternative in patients with failed coronary sinus (CS) lead implantation. However, long-term thrombo-embolic risk remains unknown. Much of the data have come from a small number of centres. We examined the safety and efficacy of endocardial LV pacing to determine the long-term thrombo-embolic risk., Methods and Results: Registries from four UK centres were combined to include 68 patients with endocardial leads with a mean follow-up of 20 months. These were compared to a matched 1:2 control group with conventional CS leads. Medical records were reviewed, and patients contacted for follow-up. Ischaemic stroke occurred in four patients (6%) in the endocardial arm providing an annual event rate (AER) of 3.6% over a 20 month follow-up; compared to 9 patients (6.6%) amongst controls with an AER of 3.4% over a 23-month follow-up. Regression analyses showed a significant association between sub-therapeutic international normalized ratio and stroke (P = 0.0001) in the endocardial arm. There was no association between lead material and mode of delivery (transatrial/transventricular) and stroke. Mortality rate was 12 and 15 per 100 patient years in the endocardial and control arm respectively with end-stage heart failure being the commonest cause., Conclusion: Endocardial LV lead in heart failure patients has a good success rate at 1.6 year follow-up. However, it is associated with a thrombo-embolic risk (which is not different from conventional CS leads) attributable to sub-therapeutic anticoagulation. Randomized control trials and studies on non-vitamin K antagonist oral anticoagulants are required to ascertain the potential of widespread clinical application of this therapeutic modality.

Introduction: The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system are implicated in arrhythmogenesis. GP localization by stimulation of the epicardial fat pads to produce atrioventricular dissociating (AVD) effects is well described. We determined the anatomical distribution of the left atrial GPs that influence atrioventricular (AV) dissociation., Methods and Results: High frequency stimulation was delivered through a Smart-Touch catheter in the left atrium of patients undergoing atrial fibrillation (AF) ablation. Three dimensional locations of points tested throughout the entire chamber were recorded on the CARTO™ system. Impact on the AV conduction was categorized as ventricular asystole, bradycardia, or no effect. CARTO maps were exported, registered, and transformed onto a reference left atrial geometry using a custom software, enabling data from multiple patients to be overlaid. In 28 patients, 2108 locations were tested and 283 sites (13%) demonstrated (AVD-GP) effects. There were 10 AVD-GPs (interquartile range, 11.5) per patient. Eighty percent (226) produced asystole and 20% (57) showed bradycardia. The distribution of the two groups was very similar. Highest probability of AVD-GPs (>20%) was identified in: inferoseptal portion (41%) and right inferior pulmonary vein base (30%) of the posterior wall, right superior pulmonary vein antrum (31%)., Conclusion: It is feasible to map the entire left atrium for AVD-GPs before AF ablation. Aggregated data from multiple patients, producing a distribution probability atlas of AVD-GPs, identified three regions with a higher likelihood for finding AVD-GPs and these matched the histological descriptions. This approach could be used to better characterize the autonomic network., (© 2018 Wiley Periodicals, Inc.)

Background: Left atrial posterior wall isolation (LAPWI) via catheter, surgical, and hybrid techniques is a promising treatment for persistent atrial fibrillation (PersAF). We investigated whether confirmation of LAPWI can be achieved using an esophageal pacing and recording electrode., Methods: Patients undergoing PersAF ablation with the intention to achieve LAPWI were enrolled. Two approaches to LAPWI were tested: (1) ablation using endocardial catheter ablation only, and (2) "Staged Hybrid" ablation with thoracoscopic epicardial ablation, followed by endocardial left atrial electrophysiological study and catheter ablation where necessary. Patients enrolled in the study all required further catheter ablation to achieve LAPWI in this group. In both the groups, esophageal recording and esophageal pacing was performed at the start of mapping and electrophysiological study and compared with endocardial electrophysiological findings. This was repeated at the end of the procedure., Results: Twenty patients (16 M, four F) were studied. Endocardial electrophysiological study showed that in none of the cases was the posterior left atrial wall electrically isolated at the start of the study. One patient with Barrett's esophagus failed to sense or pace from the esophagus at any point in the study. In the remaining 19/19, esophageal pacing captured the atrial rhythm at the start of the procedure. LAPWI was then achieved in 17/19 using endocardial catheter ablation; retesting at this point showed sensing and capture of the atrium from the esophagus was abolished. In the remainder sensing and capture persisted., Conclusions: Esophageal pacing can be used to confirm or refute electrical isolation of the left atrial posterior wall., (© 2018 Wiley Periodicals, Inc.)

Aims: Previous studies have reported the defibrillation testing during implantable cardioverter defibrillator (ICD) implantation is associated with elevated cardiac biomarkers and ST-segment electrocardiogram (ECG) changes suggesting that shocks during testing may cause harm. However, the effects of testing have not been isolated from the implant procedure itself, where lead deployment may cause myocardial damage. This prospective study examined high sensitivity troponin T (hs-TnT) levels and ECG changes during ICD implanting alone, ICD implantation with testing and device testing as a stand-alone procedure., Methods and Results: We examined hs-TnT at baseline, and 6-8 h post procedure and 12 lead ECG at baseline, and 30 s, 5 min, and 10 min post right ventricle lead deployment and post defibrillation. There was no significant change in hs-TnT levels in a group of patients (n = 11) undergoing defibrillation testing alone, while hs-TnT was significantly elevated in patients undergoing implantation alone (n = 13, median increase 96%, P = 0.005) and in patients undergoing implantation and testing (n = 13, median increase 161%, P = 0.005). There was a significant correlation between the number of lead deployments and the percentage change in hs-TnT (r = -0.51, P = 0.01), but no correlation between either the number of shocks (r = 0.26, P = 0.25) or the total delivered energy (r = 0.24, P = 0.30) and percentage change in hs-TnT., Conclusion: Implantation of ICD leads was associated with release of troponin, but we did not observe any evidence that ICD shocks alone cause myocardial injury., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

A 3-year-old man with an implanted cardioverter-defibrillator (ICD) for type 2 Brugada syndrome was admitted to coronary care unit with ventricular fibrillation electrical storm and consequent appropriate recurrent ICD shocks. The rhythm did not settle with conventional antiarrhythmics such as β-blockers and amiodarone. An isoprenaline infusion was set up with immediate stabilisation of rhythm. After a period of monitoring, the infusion was stopped and oral quinidine was started. He has remained free of problems for 1 year. This case-report summarises these novel treatments for electrical storm in Brugada syndrome and the mechanism behind them.